Provider Demographics
NPI:1851325484
Name:RITCHIE, RAND CECIL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAND
Middle Name:CECIL
Last Name:RITCHIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2514
Mailing Address - Country:US
Mailing Address - Phone:805-773-3343
Mailing Address - Fax:805-773-3342
Practice Address - Street 1:354 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2514
Practice Address - Country:US
Practice Address - Phone:805-773-3343
Practice Address - Fax:805-773-3342
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG413272084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0418629OtherEIN
G41327Medicare ID - Type Unspecified
CA77-0418629OtherEIN